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Hypofractionated versus standard radiation therapy in combination with temozolomide for glioblastoma in the elderly: a meta-analysis

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Abstract

Background

There is no clear consensus regarding the optimal treatment for glioblastoma (GBM) in the elderly. Hypofractionated radiation therapy (hRT) has emerged as a viable and comparable radiation regime compared to standard radiation therapy (sRT), however the survival effect of temozolomide (TMZ) with hRT is uncertain. The aim of this meta-analysis was to evaluate survival outcomes of hRT + TMZ vs sRT + TMZ in this specific demographic.

Methods

Searches of 7 electronic databases from inception to January 2019 were conducted following the appropriate guidelines. Articles were screened against pre-specified criteria. The progression free survival (PFS) and overall survival (OS) metrics were then extracted and pooled by meta-analysis evaluating mean difference (MD).

Results

A total of 7 individual comparative studies describing hRT + TMZ vs sRT + TMZ (n = 917) respectively satisfied inclusion criteria. Meta-analysis by random-effects modelling indicated that compared to sRT + TMZ, hRT + TMZ resulted in comparable PFS (MD 0.3 months; 95% CI − 2.4 to 2.9; I2 = 91.7%; P-effect = 0.85) and significantly shorter OS (MD − 3.5 months; 95% CI − 6.3 to − 0.6; I2 = 98.9%; P-effect = 0.02). Subgroup analysis between age definitions of elderly of > 65 vs > 70 years old both demonstrated the same significant trend with no statistical difference between the groups.

Conclusion

The combination of hRT + TMZ is feasible in well-selected elderly GBM cases, and appears to confer a statistically comparable PFS compared to sRT + TMZ. However, expectations that the OS with hRT + TMZ is comparable to that of sRT + TMZ in all elderly GBM presentations should be tempered. It is likely a specific subgroup of elderly GBM patients will benefit greatly from the addition of TMZ to hRT, and greater investigation is needed to identify their characteristics.

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Acknowledgements

Alfredo Quinones-Hinojosa is funded by the NIH (R01CA183827, R01CA195503, R01CA216855, R01CA200399, R43CA221490), Florida State Department of Health Research, the William J. and Charles H. Mayo Professorship and the Mayo Clinic Clinician Investigator.

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  1. Alfredo Quinones-Hinojosa and Kaisorn L. Chaichana are co-senior authors.

Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, 200 First St, Rochester, MN, 55905, USA

    Victor M. Lu, Panogiotis Kerezoudis, Desmond A. Brown & Terry C. Burns

  2. Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Alfredo Quinones-Hinojosa & Kaisorn L. Chaichana

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  1. Victor M. Lu
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Correspondence to Victor M. Lu or Kaisorn L. Chaichana.

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Lu, V.M., Kerezoudis, P., Brown, D.A. et al. Hypofractionated versus standard radiation therapy in combination with temozolomide for glioblastoma in the elderly: a meta-analysis. J Neurooncol 143, 177–185 (2019). https://doi.org/10.1007/s11060-019-03155-6

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